Objective To develop a framework for a comprehensive health literacy assessment system for primary school students that will provide a basis for establishing measurement tools and promoting healthy student development.

Methods An expert survey questionnaire was developed using literature review, Delphi method, expert meeting, and other methods. From December 2021 to February 2022, 13 experts in health literacy and related fields were selected for two rounds of Delphi questionnaire surveys. A comprehensive health literacy assessment index system was constructed for primary school students in different grades, including grades 1 – 2, 3 – 4, and 5 – 6. The weight coefficient was calculated using the percentage weighting method.

Results The constructed comprehensive assessment system includes three grade-specific subsystems. For students in grades 1 – 2 and 3 – 4, the subsystem includes six primary indicators (personal hygiene, healthy diet, physical activity, disease prevention and control, safety literacy, and mental health) and fifteen secondary indicators; each of the six primary indicators includes four capability dimensions of health knowledge, motivation, behavior, and skills; the subsystem for students in grades 5 – 6 has an additional primary indicator of e-health literacy, with seven primary indicators and twenty secondary indicators, along with the same four capability dimensions. The effective response rate to the expert questionnaire was 100% in the two rounds of consultation, indicating high enthusiasm of the experts; the coefficients of authority for the two rounds of consultation were greater than 0.7, confirming the reliability of the results; the Kendall′s coefficients of 0.302, 0.327, and 0.340 for the primary indicators, secondary indicators, and the four ability dimensions of the primary indicators in the second round of consultation were higher than those in the first round of consultation (P < 0.05 for all).

Conclusion The constructed framework of a comprehensive health literacy assessment system for Chinese primary school students can serve as a reference for related research on assessing students' health literacy.